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Alaska rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.56 / $2.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.89 / $1.91
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.49 / $2.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.91 / $1.41